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Anthem Blue Cross and Blue Shield Medicaid Global Nonpreferred Prior Authorization Form This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,

How to fill out global non-preferred prior authorization

How to fill out Global Non-Preferred Prior Authorization:

1. Obtain the necessary form: Begin by obtaining the Global Non-Preferred Prior Authorization form from your insurance provider. This form is typically available on their website or can be requested directly from their customer service.
2. Patient and Provider Information: Start by filling out the patient's personal information, including their full name, date of birth, address, and contact details. Include the healthcare provider's information as well, such as their name, address, and contact information.
3. Medical Justification: Provide a detailed medical justification for why the requested medication or treatment is necessary for the patient. This section should include relevant medical history, diagnosis, and any alternative treatments that have been tried and failed.
4. Prescription Details: Input the specific details of the medication or treatment being requested, including the name, strength, dosage, quantity, and frequency. If applicable, include the healthcare provider's National Provider Identifier (NPI) or Drug Enforcement Administration (DEA) number.
5. Supporting Documentation: Attach any relevant supporting documentation to strengthen the prior authorization request. This may include medical records, diagnostic test results, progress notes, or specialist recommendations. Ensure that the supporting documentation is clear, legible, and organized.
6. Submit the Form: Once all the necessary information has been filled out and supporting documentation attached, submit the completed Global Non-Preferred Prior Authorization form to your insurance provider. Follow their recommended submission method, whether it be electronically through their website or via mail.

Who needs Global Non-Preferred Prior Authorization:

1. Patients requiring non-preferred medications: Individuals who need medications that are considered non-preferred by their insurance provider will generally need to go through the prior authorization process. Non-preferred medications are usually higher-cost drugs or ones that have alternatives available on the preferred drug list.
2. Insurance plan requirements: Depending on the insurance plan, certain medications may require prior authorization, even if they are not deemed non-preferred. It is important to review the insurance policy or contact the insurance provider to determine specific requirements.
3. Prevention of potential coverage denials: Prior authorization is a necessary step to ensure that medications or treatments not typically covered by insurance are reviewed and approved. Filling out the Global Non-Preferred Prior Authorization form helps prevent potential coverage denials and ensures that patients receive the necessary medication or treatment they require.

For pdfFiller’s FAQs

What is global non-preferred prior authorization?

Global non-preferred prior authorization is a process in which healthcare providers must receive approval from a patient's insurance company before providing certain services or medications that are not on the preferred list.

Who is required to file global non-preferred prior authorization?

Healthcare providers are required to file global non-preferred prior authorization before administering non-preferred services or medications to their patients.

How to fill out global non-preferred prior authorization?

To fill out global non-preferred prior authorization, healthcare providers need to complete a form provided by the insurance company with the necessary information about the patient, the requested service or medication, and the reason for the non-preferred status.

What is the purpose of global non-preferred prior authorization?

The purpose of global non-preferred prior authorization is to control costs and ensure that patients receive medically necessary and cost-effective care.

What information must be reported on global non-preferred prior authorization?

Information such as patient's demographic information, medical history, prescribed medication or service, healthcare provider's information, and the reason for non-preferred status must be reported on global non-preferred prior authorization.

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